How Can We Begin To Measure Recovery

Recovery is a complex set of achievements, daily activities and good old fashion hard work.  It could be that recovery is only a qualitative process.  So how does one know if they are in recovery?  How do we measure recovery? I think peace of mind, acceptance, and kindness could sum it up nicely.

Here is a great article on how difficult it is to measure recovery.

Karen Dodge1*Barbara Krantz1 and Paul J Kenny2

The field of addiction treatment lacks a universally accepted and unambiguously defined clinical definition of recovery. Although a single disciplinary group such as physicians may agree upon a definition, there is no such agreement among the broader field of treatment professionals, addiction researchers, program evaluators, and policymakers. Indeed, there is no comprehensive consensus of what a definition of “recovery” is even among those individuals who are themselves in recovery from substance use disorders [1,2].

There have been many efforts to define and measure recovery from substance use disorders. Perhaps the most often used criteria for remission from substance use disorders by treatment professionals are those from the Diagnostic and Statistical Manual of Mental Disorders (DSM) [3]. An example of such a criterion is the sum of all years in which a diagnosis of alcohol use disorder was not present. However, this criterion indicates a remission from a clinical diagnosis, rather than a multidimensional perspective on recovery.

Perhaps the most comprehensive efforts to define and measure recovery were those offered by leading investigators as part of a special issue on “recovery” published by the Journal of Substance Abuse Treatment (October 2007). Methodological approaches to developing a definition of recovery included a consensus panel, literature reviews, surveys of the general public and addiction treatment professionals, and opinions from persons themselves in “recovery”.

The Betty Ford Consensus Panel [4] defined “recovery” as consisting of three parts: sobriety, personal health, and citizenship. Sobriety refers to abstinence from alcohol and all other non-prescribed drugs; personal health refers to improved quality of health; and citizenship refers to living with regard and respect for others. This conceptualization has come under criticism for several reasons, including the use of the construct of citizenship as a measure of chemical dependency recovery. The objection is that no other chronic illness is measured for recovery status on the construct of citizenship [5]. The Betty Ford panel proposed a way to measure recovery using the World Health Organization Quality of Life instrument. However, this approach has been critiqued on the ground that a measure developed for a general population may not be valid for the specific population of people in recovery [5]. Arndt & Taylor [5] view the Betty Ford conceptualization as an initial step in defining “recovery,” rather than the pinnacle of a definition.

White [6] defined “recovery” as the experience (a process and sustained status) through which individuals, families and communities impacted by severe alcoholism and other drug problems utilize internal and external resources to voluntarily resolve these problems, heal the wounds inflicted by alcohol and other drug-related problems, and develop a healthy, meaningful and productive life. White [7] subsequently proposed outcome measures for these areas including measures of substance use, living environment, physical and emotional health, family relationships, citizenship, and quality of life.

Laudet [1] cites a survey of members of the public regarding their view of recovery (Peter D. Hart Research Associates, 2004). This survey indicated that 62% reported that “in recovery from addiction to alcohol or other drugs, the one addicted is trying to stop using”. Only 22% of respondents reported that “the one in recovery is free from the disease of addiction and no longer uses alcohol or illicit drugs”. Further, 80% of respondents expressed that total abstinence was their “recovery” goal and over 80% reported that “recovery” is a process and not a finite achievement. Apart from the public’s perceptions, Laudet [1] also conducted a review of articles on recovery and concluded that most researchers operationally define recovery in terms of substance use and more often as abstinence status. Some of the terms used interchangeably were remission, resolution, abstinence, and recovery. In addition, words to represent the act of changing the substance using behaviors were quit, overcome, and recover. In these contexts, “recovery” is defined as “overcoming both physical and psychological dependence to psychoactive drugs while making a commitment to society.” This description implies domains of recovery that encompass drug abstinence, personal wellbeing, and re-integration into society.

Galanter [8] suggested a model of “recovery” from addiction that is attuned with the spiritual framework supported by Alcoholics Anonymous. This aspect of recovery is based on the substance-using individuals’ own perspectives. These experiences are not observable; rather, they are self-reported through the persons’ interpretations. This is an important domain of “recovery” and is reminiscent of the spiritual orientation of Alcoholics Anonymous.

Finally, McLellan, Chalk, & Bartlett [9] present “recovery” in terms of outcomes, performance, and quality. Calls for accountability within the addiction treatment field have inspired these authors to build a set of treatment quality, performance and outcome indicators to measure recovery. They suggest that outcomes of any treatment are the changes in clients’ symptoms, behaviors, and functioning that can be attributed to the treatment. Because clients present with multiple problems, outcome evaluations of chemical dependency treatment have measured more than one outcome variable. Outcomes to measure recovery are generally grouped together by the domain of functioning that they represent. When clients experience abstinence or a substantial reduction in use of drugs/alcohol as well as improvement in functioning in other domains (e.g., family, social, education, financial, etc.) this can be called “recovery.” The three variables that are most frequently presented as “recovery” domains are substance use, employment/self-support, and criminal activity. The Substance Abuse and Mental Health Services Administration [10] measures substance abuse “recovery” by adjoining physical health, mental health, family and social relations, stability in housing, perception of care, access, and retention domains. According to SAMSHA, improvements in three of the seven functional domains plus abstinence are considered indicative of “recovery”.

As can be seen from the above, the definition and very concept of recovery is unclear, although a convergence of ideas is beginning to emerge. It might be fundamental to consider the foregoing efforts, which represent collective federal agency/consensus panel/empirical definitions of “recovery” as a starting point meant to be reviewed, revised, expanded upon, revisited, and updated. Therefore, the purpose of this article is to move toward an abstinence-based model of recovery by using existing models and developing upon them. This article is theoretical in nature and does not present quantitative analyses. Instead it presents the results of a small qualitative effort meant to create a theoretical foundation for future research.